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Summary
BlueCross BlueShield of South Carolina is more than just the 800-pound gorilla in the Palmetto State’s healthcare market - it is parent to a family of successful subsidiary companies that provide insurance, back-office services, government plan administration, Medicare claims processing, and other services nationwide. Through those subsidiaries, it has strengthened itself financially at a time when other nonprofit Blue companies have seen declines in their reserves. As the recession takes hold, health plans in the Carolinas are scrambling to provide low-cost options to employers and individuals as price becomes the primary driver in coverage decisions. The problem-plagued North Carolina State Employee Health Plan will be taking proposals soon from vendors interested in servicing the huge 667,000-member plan. A suggestion from pharmaceutical giant Merck & Co. helped spawn a new medical home pilot project in Charleston, S.C., focused on diabetes care. The program involves BC/BS of South Carolina and Palmetto Primary Care Physicians.
Questions Answered In This Report
BC/BS of South Carolina claims to handle the insurance needs of 1.8 million South Carolinians, but at least half of those lives are enrolled in self-insured plans. How are the other players trying to compete against this behemoth? How did the company perform financially in 2008? How do its many subsidiaries contribute to the parent company’s overall business?
Unemployment continues to rise in the Carolinas, and the recession is squeezing employers who have held fast to traditional coverage products. How are health plans adapting to the recession now, and what are clients looking for? What product designs are gaining favor?
The North Carolina Blue plan was one of the first to offer coverage for weight management and obesity treatment. What does its data say about whether such coverage pays off in terms of lowered overall health costs? What parts of the Blue plan’s program are other insurers adopting? What weight-loss drugs are covered under the North Carolina insurer’s obesity benefit?
Metrics
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North Carolina Commercial HMO Enrollment, Largest 5 Plans
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North Carolina HMOs Premium Revenues, Revenue Leaders
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North Carolina HMO Premiums PMPM, Weighted Average
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South Carolina Commercial HMO Enrollment, Largest 5 Plans
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South Carolina HMOs’ Total Premium Revenues, Revenue Leaders
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South Carolina HMO Premiums PMPM, Weighted Average
Primary Research
Research includes interviews with 12 executives and data from regulatory filings with the National Association of Insurance Commissioners, HealthLeaders-InterStudy, South Carolina Dept. of Insurance, and the Centers for Medicare & Medicaid Services.
Companies Mentioned In This Report:
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Aetna
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BlueCross BlueShield of South Carolina
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Blue Cross and Blue Shield of North Carolina
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Carolina Care Plan
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CIGNA
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Financial Directions Group
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Health Dialog
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Humana
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SHPS
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Merck & Co.
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Oppenheimer & Co.
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Palmetto Primary Care Physicians
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Renaissance Health Care
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Rosenfeld Einstein
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UnitedHealthcare
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WellPath Select
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